Using rodent models, this volume explores the basic neurobiology of the relationship among chronic pain, opioid pharmacology, and addiction.

"Perioperative Addiction" addresses an issue that every anesthesiologist will encounter many times during the course of his or her career: the patient who arrives for operative care under the influence of legal or illegal drugs. The editors and contributors provide expert guidance on how to identify and manage the addicted patient, approaching the subject from the vantage points of the specific drug and of special patient populations.

Features:

Guidance for spotting and managing addicted patients

All common and important drugs of addiction, from opioids, cocaine, club drugs, and alcohol, to tobacco, marijuana, nitrous oxide, inhalants, and propofol

Special populations, including pregnant women, pain patients, adolescents, older patients, and healthcare professionals

Fascinating overview of the long history of addiction

Genetic basis of addiction, and the range of pharmacological treatments for addiction

This volume addresses neuronal pain mechanisms at the peripheral, spinal and supraspinal level which are thought to significantly contribute to pain and which may be the basis for the development of new treatment principles. Chapters on nociceptive mechanisms in the peripheral nociceptive system address the concept of hyperalgesic priming, the role of voltage-gated sodium channels in different inflammatory and neuropathic pain states, the hyperalgesic effects of NGF in different tissues and in inflammatory and neuropathic pain states, and the contribution of proteinase activated receptors (PAR) to the development of pain in several chronic pain conditions. Chapters on nociceptive mechanisms in the spinal cord address the particular role of NO and of glial cell activation in the generation and maintenance of inflammatory and neuropathic pain and it discusses the potential role of local inhibitory interneurons, of the endogenous endocannabinoid system and the importance of non-neuronal immune mechanisms in opioid signaling in the control of pain. Furthermore, it is presented how spinal mechanisms contribute to the expression of peripheral inflammation.

-- Are patients aware of the fact that pharmacological therapies stress the brain in ways which may prevent or postpone symptomatic and functional recovery ? ==================================================== Rethinking Psychiatric Drugs: A Guide for Informed Consent is a critical appraisal of the medications which an estimated 20% of Americans consume on a regular (and sometimes involuntary) basis. It is the philosophically, epidemiologically, and scientifically supported revelation of how and why psychiatry's drug therapies have contributed to a standard of care which frequently does more to harm than to cure. Extensively researched and documented, the book addresses: -- the process by which psychiatric drugs reach the market -- the history and philosophy of Evidence Based Medicine -- the common flaws in research methodologies which negate the validity of the psychiatric RCT (Randomized Controlled Trial) -- the problem of allostatic load (how drugs stress the body) -- the history, long term effects, and utility of the drugs used to suppress symptoms of depression, psychosis, inattention and hyperactivity -- the effectiveness of alternatives to medication Rethinking Psychiatric Drugs: A Guide for Informed Consent exposes the current crisis in medical ethics and epistemology, and attempts to restore to psychiatry an authentically informed consent to care.

Immune Mechanisms of Pain and Analgesia is the first volume to discuss a new concept of immune-neural interplays leading to pain or analgesia. It argues the classical view that pain and its control are restricted to the nervous system, offering a comprehensive overview of the emerging area of immune mechanisms in pain and its control. It challenges the traditional view that pain sensation or suppression is attributed exclusively to the nervous system and presents a critical analysis of this new concept. The book is written by an internationally recognized group of researchers and discusses complex and controversial issues such as cytokines and their pain-exacerbating but also analgesic effects, the production of opioids by immune cells, peripheral analgesic and anti-inflammatory actions of opioids, immunomodulatory effects of opiates, and immunosuppressive effects of pain.

The advancements of medical technology, improvements in medical care, and increased patients' life span make pain research and related drug development high priorities for both the research community and pharmaceutical companies. Rapid development of basic science research tools, such as techniques of flurometric labeling, genomic and proteomic high throughput screening, and genetically modified animals, promotes the swift acceleration of pain research to a stage allowing integrated investigations of pain processing mechanisms at the single cell and/or molecule level, and in a spatially and temporally controlled manner. Using multidisciplinary approaches, we can dissect the complicity of the sensory circuits connecting peripheral stimulation to maladaptive changes in the sensory pathways as well as pain perceptions at the central nervous system. Pain Research: Methods and Protocols, Second Edition provides advanced techniques and animal models that are critical for integrated pain research. Written in the highly successful Methods in Molecular Biology (TM) series format, chapters contain introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and notes on troubleshooting and avoiding known pitfalls. Authoritative and accessible, Pain Research: Methods and Protocols, Second Edition serves as an ideal guide to novice pain researchers who may not have extensive experiences in the field, or to experienced pain researchers who would like to expand their research in new directions and/or to new mechanisms in different models.

This book is an extension of my 1992 book entitled The Social Context of Chronic Pain Sufferers. Many ideas nominally explored there are elaborated in this volume, which is an attempt to fill a major gap in the chronic pain literature. Although there has been a virtual flood of new works on the medical and psychological aspects of chronic pain, such enthusiasm is somewhat muted in relation to the social environment of the patient. Although there is universal recognitionamongpain expertsthat biological, psychological, and socialfactors influence the experience ofpain, the social component (forreasons that are - clear) has failed to attract much attention. Theneed forabook focusedonsocialrelationsisobvious.Thepatientisnot merelyacarrierof symptoms.Thereis alargesocialrealityinthe background of each patient; that reality can have multidimensional consequences, from the way pain is perceivedto seriousfinancialhardshipand other sourcesof stress, c- plicating treatment, management, and, ultimately, the prognosis. Clinicians rec- nize the value of incorporating the social dimension in the overall evaluation and treatment of the patient. This book attempts to accomplish that task. In order to achieve that objective, this volume addresses many important e- ments inthepatient'ssocial environment-the mostsignificantbeingthefamily. Beyond the family, for a vast majority of patients, work represents a major source of economic security and self-esteem. Job loss, common in this population and a major cause of much personal and family distress, needs critical examination.

This book is a clear and comprehensive review of current knowledge concerning the myofascial trigger point pain syndrome and fibromyalgia. It covers the pathogenesis, pathophysiology, clinical manifestations and differential diagnosis of these two closely associated muscle pain disorders. A guideto specific treatment involving trigger points is outlined in detail and supported with clear illustrations.Gives a clear basis for an understanding of these specific forms of pain and their development, by reviewing and summarising a wealth of available research which is otherwise scattered in a wide variety of journals and books Offers straightforward steps to an accurate differential diagnosis in relation to these syndromesProvides a guide to treatment of pain in specific parts of the body, especially in common and chronic conditions Offers clear and practical steps to treatment which can be applied straight into practiceAddresses areas of growing interest and illuminates the debates about myofascial pain and fibromyalgia. Written by a renowned figure in this field and supported with contributions from key international figuresTwo of the worlds leading authorities on fibromyalgia, Professor Yunus in the USA and Dr Inanici in Turkey, have provided a comprehensive review of current concepts concerning all the various aspects of this commonly occurring, complex, controversial and disabling disorder.

Further management strategies including clinimetry, cranio-cervical posture and 'psychological' management of chronic facial pain are described and discussed in relation to their integration in daily practice. Difficult clinical problems such as cervical headache, chronic ear pain in children, KISS syndrome, facial paralysis, tinnitus, craniomandibular dysfunction amongst others are described and discussed. A clinical reasoning approach to problem solving is emphasized throughout. This book is recommended for those interested in manual assessment and management of the craniofacial region including clinicians, physiotherapists, dentists, orthodontics, ENT-specialists, neurologists, maxillofacial surgeons, chiropractors and osteopaths. Foreword by Professor Mariano Racobado, Santiago, Chile. Contributors: HAJ Oudhof: Skull Growth in relation to mechanical stimulation Dr H Biedermann: Features of cranial tissue as a basis for clinical pattern recognition on management Dr med H Biederman: Primary and secondary cranial asymmetry in Kiss-children R Spermon-Marijne: Manual Therapy of the craniofacial region as therapeutic Dr J R Spermon: approach in children with long term ear disease P Westerhuis: Cervicogenic headache: a clinician's perspective and Cervicogenic Headache, physical examination and management David Butler: Experience of pain and the craniofacial region D Fitzgerald and Lynn Bryden: The influence of posture and alteration of function upon the cranio-cervical and craniofacial region M Jones: Clinical reasoning. A basis for examination and treatment in the cranial region F Winters: Pain management by patients with chronic craniofacial pain G Aufdemkampe: The relevance of clinimetrie by patients with cranial facial pain * Prestigious text with expert international contributors including acclaimed anatomists and cranial morphologists * Highly practical text with a page of text facing a page of high quality black and white photographs * Geoff Maitland has endorsed this text

Anesthetics produce a reversible state of unconsciousness accompanied by ante- grade amnesia. This remarkable phenomenon brings great relief to surgical patients and wonder to clinicians and scientists. To date, we do not fully understand the mechanisms by which anesthetics ablate conscious sensation and memory. We are, however, making progress. This book presents original results as well as overviews of the current state of knowledge of the problem. It is authored by investigators who know the ?eld well; their research at a number of levels has contributed substantially to our c- rent understanding of anesthetic modulation of memory and consciousness. Most of the contributors were presenters at two workshops organized by Dr. Pearce and Dr. Hudetz at the 40th Annual Winter Conference on Brain Research, held at Snowmass Village, Colorado, from January 27 through February 2, 2007. One workshop focused on anesthetic modulation of consciousness and another on an- thetic modulation of memory. Seven of the chapters are based on material presented at these symposia - appropriately updated with new relevant ?ndings. This infor- tion is supplemented by chapters on anesthesia and sleep, computational analysis of the state of anesthesia, and the clinical phenomenon of "anesthesia awareness," a topic that has recently received much public attention. With these three additional contributions, the book thus includes 10 chapters.

Pain Management and Anesthesiology contains the presentations made at the 43rd Annual Postgraduate Course in Anesthesiology sponsored by the University of Utah and held at Snowbird, Utah, USA, February 20-24, 1998. This volume addresses recent advances in the understanding of the basic science and clinical management of pain. The textbook includes sections on recent advances in the understanding of pain signal processing, as well as reviews of the clinical management of acute, chronic, cancer-related, and pediatric pain. In addition, this text includes a discussion of the behavioral assessment and treatment of the pain patient. This textbook is the sixteenth in a continuing series documenting the proceedings of the postgraduate course.

Patients with chronic pain present a unique set of challenges to the primary care clinician. In Chronic Pain: A Primary Care Guide to Practical Management, Second Edition, leading pain specialist Dawn A. Marcus, MD, again offers practical, clear, and succinct evidence-based approaches to the diagnosis and treatment of the myriad painful conditions clinicians see in their offices every day, such as headache, back pain, arthritis, fibromyalgia, and abdominal pain. Sections addressing pain management in children, pregnant women, and seniors are also included. This new edition is designed to provide a pragmatic approach to assessing and treating the complex issues and characteristics of chronic pain patients. New chapters expand upon the evidence-based recommendations and practical office tools previously provided, with the addition of new chapters addressing risk management; pain syndromes in the shoulder, upper extremity, and lower extremity; and cancer and end-of-life pain. Of special value, the charting forms and patient educational materials on CD-ROM have been expanded to include ready-to-use screening tools for depression and anxiety, neuropathic pain tools, and fibromyalgia assessment tools. Chronic Pain: A Primary Care Guide to Practical Management, Second Edition provides strategies and techniques that are designed to improve the confidence with which the primary care physician can approach patients with complex pain complaints, reduce staff stress, and improve patient success.

This text highlights the value of a team approach to appreciating the commplexity of spinal pain and a range of treatment approaches. Contributions from epidemiology, anatomy, pathology, biomechanics, clinical medicine orthopaedics, chiropractic, osteopathy and physiotherapy are presented. Each section is written by an experienced practitioner and provides a summary of pertinent material, seeking to improve the reader's understanding of the causes of cervical spine pain The volume is part of a series of three books bringing together a multidisciplinary approach to the management of mechanical spinal pain.

Headache Medicine has recently become an official medical subspecialty. Practitioners who specialize in the field come from many different backgrounds including neurology, internal medicine, anesthesiology, rehabilitation medicine, family medicine, psychiatry, dentistry and others. A great deal of research is being done in HM, and, as a result, the field is one which is growing rapidly in every way. Interestingly, most patients with headache are not being treated by specialists in HM, in large part because of the vast numbers of patients requiring medical attention for headache disorders, and the relatively small number of bona fide specialists. Thus, there is a need for resources to guide these practitioners as they manage headache patients. There are several excellent scholarly texts in the field and numerous books for the public about headache. There are really no concise manuals of HM, however, there are books aimed at the bulk of skilled practitioners taking care of the major share of headache sufferers, who wish to understand the important concepts of diagnosis, treatment, and prognosis in this complex field. This is the aim of Dr. Levin's book which consists of 4 parts: Part 1- Headache Medicine Basic Science, Part 2- Diagnosis of Primary Headache Disorders, Part 3- Diagnosis of Secondary Headache Disorders, and Part 4- Headache Treatment.
Chapters in each section are concise, but include cutting edge information about these aspects of headache medicine. The organization of the contents of this book is similar to the Curriculum for Headache Medicine designed by the United Council for Neurologic Subspecialties (UCNS) which is the organization responsible for accreditingHeadache Medicine training programs and accrediting individual practitioners. The content of the book mirrors that of the UCNS board examination as well. Chapters include key tables and illustrations. Review questions are included at the end of each chapter and serve as a study resource. The editor is a charter diplomate of the UCNS HM examination and has directed board review courses for the American Headache Society and Headache Cooperative of New England. All of the eligible chapter authors have taken and passed this exam as well. The International Classification of Headache Disorders is used throughout this text and a concerted effort has been made to base content on evidence when available, rather than personal practices. Each chapter is intended as a stand alone monograph and as a result the book can be read in virtually any order.

This volume comprises the edited presentations of the 40th Annual Postgraduate Course in Anaesthesiology, February 1995. It reflects recent advances in this area. Obstetrical and paediatric patients constitute important and often challenging cases for the practicing anesthesiologist. This textbook is the 13th in a continuing series documenting the proceedings of the Postgraduate Course of the Department of Anesthesiology of the University of Utah School of Medicine.

Anesthesiology and the Cardiovascular Patient contains the edited presentations of the 41st Annual Postgraduate Course in Anesthesiology, February 1996. The chapters reflect new data and concepts within the general framework of the pathophysiology and management of surgical candidates with cardiovascular disease. The textbook will serve as a vehicle to bring many of the latest concepts in anesthesiology to those who did not attend the conference. Each chapter is a brief but sharply focused glimpse of the current interest in anesthesia. This volume, as well as past and future volumes, reflects the rapid and continuing evolution of anesthesiology in the late twentieth century.

Midwives in all the developed countries are also taking increased professional responsibility for the management of all aspects of labour including pain control. Alternative methods of pain relief by midwives are being used increasingly, and will continueto be while the use of drugs such as pethidine for controlling labour pain is no longer routine. No book has existed till now which looks at the subject in the light of these changes from the midwife's point of view. Existing titles are very medical and pharmacological in approach. This book looks at all aspects of pain relief in labour, covering the physiological processes involved in the perception of pain and relates them to the physiological process of labour. Management of pain in labour is dealt with from the midwife's point of view and particular emphasis is given to non-pharmacological methods of pain control, including complementary therapies. Pharmacological methods of pain control are also included.Examines pain management in labour from the point of view of the modern professional midwife Includes coverage of the physiological processes of pain and relates them to the physiological process of labour and the practical aspects of pain management in labour At the right level for today's more academic courses (including post-basic diploma students), and for the midwife as an independent professional Illustrated with clear line drawings to supplement and clarify the text Written by an experienced clinical midwife and midwifery teacher (Sue Moore), with 14 years of previous clinical experience in both hospital and the community

Drawing on the expertise of historical, literary and philosophical scholarship, practicing physicians, and the medical humanities this is a true interdisciplinary collaboration, styled as a history. It explores pain at the intersection of the living, suffering body, and the discursive cultural webs that entangle it in its specific moment.

Regional Analgesia in Obstetrics provides an account of the developments in the provision of regional analgesia and anaesthesia in obstetrics over the last decade. The book covers the attitudes to obstetric analgesia in different countries; the indications for regional analgesia in labour; the effects of regional analgesia on outcome; and operative delivery.

close circle of anaesthetic scientists but, with the help of computer technology, has greatly influenced the practice of the modern clinical anaesthesiologist. The efforts of anaesthesiologists, pharmaceutical companies, and the development of the internet has lead to a situation that now almost every anaesthesiologist can be in close contact to anaesthetic pharmacology computer simulation pro grams and target controlled infusion devices. These two tools allow us to in crease our understanding and improve the controllability of anaesthetic drug administration, on site, in the operating theatre. In Europe the growing enthusi asm regarding the study and practice of intravenous anaesthesia has lead to an increased output of manuscripts on this subject, the initiation of workshops on the pharmacology of anaesthetic agents and the formation of a society that embodies this spirit; the European Society for Intravenous Anaesthesia, the EuroSIVA. EuroSIVA The concept of EuroSIVA has been to provide a forum to co-ordinate, facilitate and promote high quality presentations in the area of intravenous drug admini stration. The first two meetings held in 1988 in Barcelona and 1999 in Amster dam achieved these aims. During the Barcelona and Amsterdam meetings pre senters of over 10 countries shared their knowledge with 250 and 400 partici pants, respectively. In addition to the EuroSIVA meetings the international board aims to promote education for those involved with intravenous anaes thesia."

Sodium channels confer excitability on neurons in nociceptive pathways and exhibit neuronal tissue specific and injury regulated expression. This volume provides recent insights into the control of expression, functioning and membrane trafficking of nervous system sodium channels and reviews why sodium channel sub-types are potentially important drug targets in the treatment of pain. The roles of sodium channels in dental and visceral pain are also addressed. The emerging role of sodium channel Nav1.3 in neuropathic states is another important theme.

Authors from the pharmaceutical industry discuss pharmacological approaches to the drug targeting of sodium channels, and in particular Nav1.8, exclusively expressed in nociceptive neurons. The final chapter highlights the functional diversity of sodium channels in part provided by post-transcriptional processing and the insights into sodium channel function that are being provided by tissue specific and inducible gene knock-out technology.

Pain and inflammation are inextricably linked phenomena. The observation that chemical mediators with combined pro-inflammatory, algesic and/or hyperalgesic activity occur at the site of inflammation is fundamental not only to our present understanding of the inflammatory process but also to our attempts to devise clini- cally useful anti-inflammatory therapies. Over a hundred years ago it was recognised that primary sensory neurones play a crucially important "dual" role in inflammation. By affecting the transfer of infor- mation from peripheral nociceptors to the spinal cord, a subpopulation of sensory nerves {"pain fibres"} initiate algesia and hyperalgesia, whose sensations are then modified and fine-tuned in the central nervous system. Equally important is the release from the peripheral terminals of sensory neurones of neuropeptides, the acute effects of which are observed as changes in microvascular tone and perme- ability leading to neurogenic inflammation. Over the last decade it has become increasingly clear that this view of the func- tion of sensory nerves is somewhat over-simplified. For example, the mechanisms underlying hyperalgesia may, in certain circumstances, be mimicked in other condi- tions such as the hypersensivity associated with asthma. Furthermore, it has become increasingly evident that over a longer time period the release of neuropeptides from peripheral sensory nerve endings may also have modulating effects on inmune cells and that this may be relevant to chronic inflammatory disease and possibly also to inflammatory hyperalgesia.